Immune reconstitution inflammatory syndrome: the trouble with immunity when you had none

DL Barber, BB Andrade, I Sereti, A Sher - Nature reviews Microbiology, 2012 - nature.com
DL Barber, BB Andrade, I Sereti, A Sher
Nature reviews Microbiology, 2012nature.com
Some individuals who are infected with HIV rapidly deteriorate shortly after starting
antiretroviral therapy, despite effective viral suppression. This reaction, referred to as
immune reconstitution inflammatory syndrome (IRIS), is characterized by tissue-destructive
inflammation and arises as CD4+ T cells re-emerge. It has been proposed that IRIS is
caused by a dysregulation of the expanding population of CD4+ T cells specific for a co-
infecting opportunistic pathogen. Here, we argue that IRIS instead results from hyper …
Abstract
Some individuals who are infected with HIV rapidly deteriorate shortly after starting antiretroviral therapy, despite effective viral suppression. This reaction, referred to as immune reconstitution inflammatory syndrome (IRIS), is characterized by tissue-destructive inflammation and arises as CD4+ T cells re-emerge. It has been proposed that IRIS is caused by a dysregulation of the expanding population of CD4+ T cells specific for a co-infecting opportunistic pathogen. Here, we argue that IRIS instead results from hyper-responsiveness of the innate immune system to T cell help, a mechanism that may be shared by the many manifestations of IRIS that occur following the reversal of other types of immunosuppression in pathogen-infected hosts.
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